Implementation Considerations

Accreditation, and similar mechanisms such as regular programme reviews, are well established in some countries (Australia, Canada, South Africa, USA), developing in others, and weak or absent in quite a number, particularly among lower income countries. A first action might be to raise awareness of the potential gains in quality and relevance that come with well-conducted accreditation practices. Political commitment to higher quality education is the first component to be considered in developing accreditation mechanisms, as some educational bodies may feel that accreditation threatens their vested interests, particularly if the objective is to sanction rather than to help institutions to improve their performance. Examples of successful practices need to be analysed and disseminated. Fostering voluntary accreditation may increase the commitment of participating institutions and the legitimacy of the whole process, which can be seen as a “social contract” between institutions and the community (Dussault, 2008). Being accredited by a reputable mechanism and accrediting body brings status and recognition, and can be a strong incentive to maintaining high standards.

Global cooperation and collaborative efforts aid in setting standards and assisting countries in developing the capacity for local adaptation and implementation, and in facilitating information exchange (Frenk, et al., 2010). The Global Consensus on Social Accountability and the long-standing WHO agenda on social accountability of health professions’ schools can serve as basis for such cooperation.

In many countries, the essential components of internationally accepted regulatory good practices are missing. This is especially true in low-income countries where regulators, in particular professional councils, may lack the authority, resources or even technical capacity to ensure effective regulation. In such cases, the state should be the regulator and gradually delegate licensure and authority as professional groups’ capacity develops (Dussault 2008). Care must be taken that quality assurance regulation does not restrict flexibility in the delegation of tasks or in the co-sharing of certain rights to practice. This would have negative effects such as making team work less effective, or limiting the possibility of creating new cadres who could help mitigate the shortages of certain professional groups, and provide essential care particularly to underserved populations. There is broad consensus that the accreditation of institutions is needed to ensure quality of care and patient safety, but there is no universal way of doing it.

The lack of evidence and studies assessing the impact of health professionals accreditation as part of regulation does not mean that there should be no regulation. In spite of the low quality of evidence, the panel decided to issue a strong recommendation because a very high value was placed on an uncertain but potentially important impact on both the quality and relevance of the health workforce.